As a mother of one, I am rather shocked that there are still many women out there who are planning for pregnancy but doesn't understand the importance of nutrient supplement for pregnancy (or rather the fetus). Folic acid, also known as folate or Vitamin B9 is one particular important nutrient that has to be taken as a supplement before conception. It is a proven nutrient to prevent neural tube birth defects (NTD), such as spina bifida (1). Why do you need it as a supplement? The reason is because it is extremely difficult to eat enough foods rich in the vitamin to supply the amount that experts recommend you take in pregnancy. In Australia about 70 babies per year are born with a neural tube defect, which is around 2.5 in every 10,000 babies born. Neural tube defects remain an important, preventable cause of mortality and morbity.
Recommended by The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists, folic acid should be taken for a minimum of one month before conception and at least for the first 12 weeks of pregnancy. The recommended dose of folic acid is at least 0.4mg daily on top of a normal diet to aid the prevention of NTD. Where there is a known increased risk of NTD (patients taking anticonvulsant medication, pre-pregnancy diabetes mellitus, previous child or family history of NTD or BMI>30), or a risk of malabsorption, a 5mg daily dose is recommended. Deficiency in folate not only increases the chances of miscarriage but also causes abnormalities in both mothers (anemia, peripheral neuropathy) and fetuses (congenital abnormalities).
Because folic acid is so important, fortification of grain products with folic acid has been mandatory in the United States since January 1998 and in Canada since December 1998. The many other benefits of folic acid in pregnancy includes: prevention of anemia, prevention of preterm birth, prevention of congenital heart diseases and oral clefts (2).
The recommended upper limit for folate supplementation is currently at 1mg for a normal pregnancy but more research is needed in terms of the risks of high dose folate supplementation. Early data suggest supplementation with l-methylfolate (a derivative of vitamin folate) rather than folic acid may mitigate these risk.
Please note that folic acid in foods is destroyed by overcooking, so opt for a big bowl of green leafy salad daily to top up your folic acid requirement.
1. Greenberg JA, Bell SJ, Guan Y, Yu Y. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention.
Reviews in Obstetrics and Gynecology. 2011;4(2):52-59.
2. Bailey LB, Berry RJ. Folic acid supplementation and the occurrence of congenital heart defects, orofacial clefts, multiple births, and miscarriage. Am J Clin Nutr. 2005 May;81(5):1213S-1217S. Review. PubMed PMID: 15883454.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research